EMPLOYMENT

    Okam Healthcare & Nurse Staffing Application

    Shift Preference:

    Licenser:

    Certifications:

    Has your professional license or certification ever been investigated or suspended?

    Are you eligible for rehire at all previous and current positions?

    Health Condition:

    Are you employed now?

    If so, may we contact your current employer?

    Employment History

    May we contact?

    Was this travel?

    Was this Agency?

    May we contact?

    Was this travel?

    Was this Agency?

    May we contact?

    Was this travel?

    Was this Agency?

    May we contact?

    Was this travel?

    Was this Agency?